Sensitivity of a Vacuum Aspiratory Culture Technique for Diagnosis of Localized Cutaneous Leishmaniasis in an Endemic Area of Leishmania (Viannia) braziliensis Transmission

Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochi's vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1 percent; (CI95 percent 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9 percent) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers

Sensitivity of Lymph Node Aspiration in Localized Cutaneous Leishmaniasis Due to Leishmania (Viannia) braziliensis

Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochi's vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6 percent and 34.5 percent for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3 percent. There was no agreement between methods (Kappa Index = -0.084; CI95 percent -0,45; 0,28) showing the potential complementary roles in diagnostic approach

Needle autopsy

Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.

Estudo terapêutico aberto com sulfato de aminosidine na leishmaniose mucosa causada por Leishmania (Viannia) braziliensis / Open therapeutic study with aminosidine sulfate in mucosal leishmaniasis due to Leismania (Viannia) braziliensis

From September to November 1994. 21 patients with active mucosal leishmaniasis were treated with aminosidine sulphate 16 mg/kg/day by intramuscular injection for 20 days. They were principally adult male agricultural workers. Thirteen patients had not received specific treatment and eight had failed to respond to Glucantime therapy. Diagnosis was based on clinical and epidemiological observations, a search for the parasite, leishmanin skin sensitivity and indirect fluorescent antibody serological tests. Sixty seven percent of patients had leishmania parasites isolated from inoculated hamsters or visualized in imprints or histopathological sections. The mean follow-up period was 12.6 months. All patients completed treatment. Side effects were pain at the injection site (86 per cent); mild proteinuria (24 per cent), elevated serum creatinine (.5 per cent) and subclinical bearing loss in one of two patients who did audiometric tests. Clinical cure was achieved in 48 per cent and the accumulated relapse rate was 29 per cent(4/14).

Medida do volume da úlcera cutânea na leishmaniose tegumentar / Measuring of the volume of skin ulcer in tegumentary leishmaniasis

Skin ulcers by Leishmania (Viannia) braziliensis are often deep and irregular and are difficult to measure by just the skin surface transverse and longitudinal diameters. The proposal is to mould the cavity, after local asepsis with fresh water plus soap, with a gelatinous plastic which contains silence, potassium alginate, calcium sulphate, magnesium oxide commercialized under the name of jeltrate (Dentsply Laboratory), by solving 9.5g of jeltrate in 20ml of fresh water and applying the gel on the ulcer which solidifies in 5 minutes. This mould is then filled with a self polymerising acrylic and its volume measured either by weight (by using an analytical balance)-technique 1-or by water displacement by applying Archimeds'principle-technique 2. We show data in a field trial before and after 20 days treatment in 20 patients using three different schedules as follows: 7 received pentamidine isethionate, 7 patients received aminosidine sulphate and 6 received meglumine antimoniate. The results point out that there was a uniform reduction of ulcer volume occurred during this period in the three groups, in both technique. Regarding the therapeutic schedules we are sure that there was a significant statistical difference between the three schedules using the T Student Test, which showed that aminostdine sulphate produced a better volume reduction of the ulcer than the other drugs. Serial moulds reflect clinical billing and are a permanent record. We conclude that the measure of the volume of the skin ulceration can be useful in the therapeutic evaluation, as a practical and cheap procedure, and may be used in field trials.

Estudo comparativo entre antimoniato de meglumina, isotianato de pentamidina e sulfato de aminosidine, no tratamento de lesöes cutâneas primárias causadas por Leishmania (Viannia) braziliensis / Comparative study between meglumine antimoniato, pentamidine isothianate and aminosidine sulphate, in the treatment of cutaneous primary lesions, caused by Leishmania (Viannia) braziliensis (L(V)b)

With the aim of comparing the therapeutic efficacy, tolerability and toxicity of meglumine antimoniate, aminosidine sulphate and pentamidine isethionate, a field study was conducted on randomized treatment of patients with primary cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis (L(V)b), in Corte de Pedra, BA, from October 1992 up to January 1993. Forty six patients were treated and distributed into three groups, two with 15 and one with 16 subjects. All patients were submitted to clinical examination, histopathological and immunological investigations, as diagnostic criterium. All patients were treated by intramuscular route. Group 1 received pentamidine 4 mg/kg/every 2 days, for 8 applications; Group 2 received aminosidine 20 mg/kg/day, for 20 days, and Group 3 received meglumine 10 mg Sbv/kg/day, for 20 days. Failure of therapy was defined as ulceration of the skin lesion four months after treatment. Such failure occurred in five cases as follows: two cases in patients of group 1 one case in patients of group 2, and two cases in group 3, after the first year of follow up. In the evaluation after three years we reviewed fifteen patients, five in each group; except for one in Group 3, all of them were cured. Statistical significance of the results between the three schedules used was not verified.

Características físico-químicas do antimoniato de meglumina em diferentes condiçöes de armazenamento / The physicochemical characteristics of meglumine antimoniate under several storage conditions

During the period October 1992 to July 1995 we measured the osmolarity and pH of ampoules of meglumine antimoniate (glucantime) from lot 9206L-004 (manufactured by Rhodia Farma Ltd, of Säo Paulo, SP, Brazil) maintained in three temperature conditions namely 4 degrees C, 37 degrees C and ambiental. Although we observed statistically significant differences in osmolarity between samples, the limited number of measurements and the variation of this property in ampoules maintained at the same temperature were obstacles to obtain definitive conclusions. Such a variation was not found with pH. Assuming these parameters could reflect structural changes in the pentavalent antimony molecule, clearly further better controlled experiments are indicated.

Plants used in treatment of leishmanial ulcers due to leishmania (viannia) braziliensis in an endememic area of Bahia, Brazil

This paper records the plants used in the treatment of cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis (L(V)b) among the rural population of a cocoaproducing coastal area of Bahia state, Brazil. An enquiry conducted among a hundred patients identified 49 plant species used to treat skin ulceration caused by this Leishmania species. The principal plants used are caju-branco (Anacardium occidentale- Anacardiaceae), used by 65 per cent of the population, folha-fogo Clidemia hirta-Melastomataceae) 39 per cent, alfavaca-grossa Plectranthus amboinicus - Lamiaceae) 33 per cent, mastruz Chenopodium ambrosioides - Chenopodiaceae) 31 per cent, erva-de-santa-maria (Solanum americanum - Solanaceae) (25 per cent) and transagem (Plantago major - Plantaginaceae) 2 per cent.

Estudo evolutivo da leishmaniose mucosa (7 a 17 anos de seguimento) causada por Leishmania (Viannia) braziliensis em Três Braços, Bahia / Follow-up of 7-17 years of patients with mucosal leishmaniases caused by Leishmania (Viannia) braziliensis in Três Braços, Bahia

Seventy seven (68 per cent) patients with mucosal leishmaniasis recorded during the period 1976-1986 in the region of Três Braços, Bahia were traced and re-evaluated clinically, diagnostically and therapeutically. Sixty-five patients were alive. The families of 12 dead patients were interviewed about probable cause of death. The 65 patients had a fresh clinical examination supplemented when necessary by a skilled ENT examination. All had a titre of circulating immunofluorescent antibodies estimated at the time. Eight patients with active mucosal lesions had triturated biopsies which were cultivated in NNN medium and inoculated in hamsters to attempt to recover Leishmania. The isolates were identified by monoclonal antibodies as Leishmania (Viannia) braziliensis. Fifty-six (86 per cent) patients were judged clinically cured. Nine (13 per cent) had active lesions. Of the 12 patients who died 5 (41 per cent) had no signs of activity at death. Mucosal leishmaniasis was thought to be the direct cause of death in 3 patients. The field treatment programme at Três Braços has managed to clinically cure 61 patients (79 per cent) during 17 years. Follow-up periods were a mean of 10 years (range 7-17).

Eficácia do sulfato de aminosidine na leishmaniose visceral grave, resistente ao tratamento com antimonial pentavalente / Effectiveness of aminosidine sulphate in severe visceral leishmaniasis, resistant to the treatment with pentavalent antimony

Descreve-se um caso de calazar grave resistente a dez cursos de antimonial pentavalente (glucantime) à base de 20mg de Sb5/kg/dia, que respondeu favoravelmente ao sulfato de aminosidine intramuscular na dose de 2Omg/kg/dia por 20 dias, repetido após 20 dias. O parasitismo esplênico passou de 50 parasitos por campo a 3 parasitos em 10 campos logo após a primeira série de sulfato de aminosidine, tornando-se negativo depois de sete meses. A melhora clínica foi imediata, com reduçao gradual da hepatoesplenomegalia, e desaparecimento 26 meses após. Neste período aumentou 13 kg. Após o uso de aminosidine a reaçao de Montenegro tornou-se positiva e as células mononucleares responderam quando estimuladas com antígenos de leishmânia.

Situaçäo atual das doenças parasitárias endêmicas, no Brasil / Present situation of endemic parasitic diseases in Brazil

Há 18 anos, as doenças parasitárias endêmicas, em nossa unidade de pesquisa, de acordo com o número de casos atendidos eram, em ordem de importância, as seguintes: doença de Chagas, esquistossomose, malária e leishmaniose. Hoje, essa ordem mudou para malária, leishmaniose, doença de Chagas e esquistossomose. A malária constitui um problema de saúde pública na Amazônia, devido à migraçäo de brasileiros näo-imunes e ao modo de vida indisciplinado dos garimpeiros que, por via aérea, atingem os rincões mais distantes do país, sem as devidas medidas de proteçäo. Quanto às leishmanioses, o calazar tem causado epidemias na periferia de várias capitais nordestinas. A Leishmania viannia guyanensis é a causa principal da doença, na bacia Amazônica, enquanto a Leishmania viannia braziliensis predomina nas regiões central e sul do Brasil. Para todas as leishmanioses, o antimoniato de meglumina ("glucantime") continua como medicamento de primeira linha, devendo ser armazenado a 4 graus C, em ambiente escuro. A transmissäo natural da doença de Chagas ao homem está praticamente sob controle, mas a transmissäo congênita e a transfusional continuam, embora com baixos índices. Para a esquistossomose, existem duas drogas efetivas que as crianças infectadas, em idade escolar, devem usar, para evitar a forma hepatoesplênica. Com o surgimento da AIDS, a importância dos protozoários intestinais aumentou, sendo descobertos novos agentes patogênicos.